PAR-Q FORM

If you are planning to become much more physically active than you are now, start by
answering the seven questions in the box below. Please read the questions carefully and
answer each one honestly: check YES or NO

YES

NO

1. Has your doctor ever said that you have a heart condition and that you should only
do physical activity recommended by a doctor?

YES

NO

2. Do you feel pain in your chest when you do physical activity?

YES

NO

3. In the past month, have you had chest pain when you were not doing physical
activity?

YES

NO

4. Do you lose your balance because of dizziness or do you ever lose consciousness?

YES

NO

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be
made worse by a change in your physical activity?

YES

NO

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood
pressure or heart condition?

YES

NO

7. Do you know of any other reason why you should not do physical activity?

YES to one or more questions

A medical clearance form is required of all participants who answer yes to any of the eight PAR-Q questions.
Note: Personal training staff reserve the right to require medical clearance from any client they feel may be at risk.

Discuss with your personal doctor any conditions that may affect your exercise program.

All precautions must be documented on the medical clearance form by your personal doctor.

NO to all questions
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

start becoming much more physically active - begin slowly and build up gradually. This is
the safest and easiest way to go.

take part in a fitness appraisal - this is an excellent way to determine your basic fitness so
that you can plan the best way for you to live actively. It is also highly recommended that
you have your blood pressure evaluated. If your reading is over 144/94, talk with your

doctor before you start becoming much more physically active.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

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